Effectiveness, safety, and tolerability of bilastine 20 mg vs levocetirizine 5 mg for the treatment of chronic spontaneous urticaria: A double-blind, parallel group, randomized controlled trial.

Chronic spontaneous urticaria (CSU) is a debilitating condition, adversely affecting the patient's quality of life. Bilastine is a recently introduced, non-sedative H1-antihistamine for its treatment. We wanted to compare the effectiveness, safety, and tolerability of bilastine 20 mg vs levocetirizine 5 mg in moderate-to-severe CSU. We conducted a double-blind, randomized controlled trial with two groups: bilastine 20 mg (n = 31) and levocetirizine 5 mg (n = 27), once daily for 42 days. We included patients (18-65 years), with moderate-to-severe CSU. UAS7, VAS, and DLQI were used to assess severity of urticaria, global urticaria-induced discomfort and quality of life, respectively. DLQI was assessed at baseline (D0) and end-of-treatment (D42), while UAS7 and VAS were noted at baseline and all follow-up visits. Assessment of UAS7 alteration was our primary objective, while changes in DLQI and VAS were the secondary outcomes. Safety was assessed by recording drug-related adverse events, biochemical investigations, and electrocardiogram, along with tolerability and compliance. Both drugs significantly improved UAS7, DLQI, and VAS at end-of-treatment (D42) compared with baseline (intra-group). At the end-of-treatment, all parameters showed greater improvement with bilastine, but only UAS7 reduction was significant (bilastine > levocetirizine, P = .03). In both the groups, UAS7 and VAS improved significantly D14 onwards, and was maintained throughout the study. Sedation was significantly less with bilastine (P = .04), while neither drug showed any serious adverse-effect. Tolerability of both drugs was similar. Therefore, bilastine was found to be a more effective and less-sedative novel therapy for CSU compared to levocetirizine, with similar effect on quality of life.

Jellyfish Envenomation Presenting with Delayed Identical Cutaneous Lesions in a Mother and Child.

Jellyfish envenomation can present with local cutaneous lesions both immediate and delayed. While the immediate reaction is toxin mediated, an immune mechanism is responsible for the delayed eruptions. This is a report of a mother and child who developed identical papular lesions in a bizarre, linear distribution after coming in contact with jellyfish almost simultaneously while on holiday. Histology showed focal basal cell degeneration along with peri-vascular and peri-appendageal lympho-mononuclear infiltrate. Both patients responded well to topical tacrolimus.

Serendipity and its role in dermatology.

Serendipity is a pleasant surprise of finding a particularly useful information while not looking for it. Significant historic events occurring as a result of serendipity include the discovery of the law of buoyancy (Archimedes principle) by the Greek mathematician Archimedes, of the Americas by Christopher Columbus and of gravity by Sir Isaac Newton. The role of serendipity in science has been immensely beneficial to mankind. A host of important discoveries in medical science owe their origin to serendipity of which perhaps the most famous is the story of Sir Alexander Fleming and his discovery of Penicillin. In the field of dermatology, serendipity has been responsible for major developments in the therapy of psoriasis, hair disorders, aesthetic dermatology and dermatosurgery. Besides these many other therapeutic modalities in dermatology were born as a result of such happy accidents.

Topical corticosteroid addiction and phobia.

Corticosteroids, one of the most widely prescribed topical drugs, have been used for about six decades till date. However, rampant misuse and abuse down the years has given the drug a bad name. Topical steroid abuse may lead to two major problems which lie at the opposing ends of the psychosomatic spectrum. Topical steroid addiction, a phenomenon that came to be recognized about a decade after the introduction of the molecule is manifested as psychological distress and rebound phenomenon on stoppage of the drug. The rebound phenomenon, which can affect various parts of the body particularly the face and the genitalia has been reported by various names in the literature. TC phobia which lies at the opposite end of the psychiatric spectrum of steroid abuse has been reported particularly among parents of atopic children. Management of both conditions is difficult and frustrating. Psychological counseling and support can be of immense help in both the conditions.

Single lesion of sarcoidosis presenting as cicatricial alopecia: a rare report from India.

Sarcoidosis affects different systems of the body including the skin where it can affect various cutaneous sites. Among these sites, the scalp is a very unusual location for lesions of sarcoidosis. Sarcoidosis of the scalp can very rarely be accompanied by cicatricial alopecia. We report here a rare case of sarcoidosis of scalp with cicatricial alopecia. To the best of our knowledge, this is the first such report from India.

Tender skin nodules in a newborn.

Subcutaneous fat necrosis of infancy is a rare disorder of subcutaneous adipose tissue that is sometimes complicated by hypercalcemia. Complete resolution is common. From the pediatrician's point of view, the disease is a rare but important cause of inconsolable cry in a newborn.

Naevoid Psoriasis and ILVEN: Same Coin, Two Faces?

The true existence of naevoid psoriasis and inflammatory linear verrucous naevus as distinct entities has been a debatable issue. Each has been opined to be a variant of the other. Considerable clinical and histological resemblance is seen between the two conditions. We describe three cases which attempt to throw more light on this issue.

Coexistence of papulonecrotic tuberculide with lichen scrofulosorum.

Tuberculides, the supposedly immunologic reactions to the products of dead Mycobacterium tuberculosis bacilli deposited in the skin from distant foci of tubercular infection, are presently considered to be of two types-papulonecrotic tuberculide and lichen scrofulosorum. Simultaneous occurrence of both the types in the same patient is very rare. We report the case of an adult male without any known internal tubercular focus who showed two types of skin lesions, clinically typical and histopathologically consistent with the diagnoses of papulonecrotic tuberculide and lichen scrofulosorum, occurring simultaneously. Polymerase chain reaction showed the presence of Mycobacterium tuberculosis DNA in papulonecrotic tuberculide type of lesion, and both types of lesions responded promptly to anti-tubercular drugs.

Triazole-Au(I) complexes: a new class of catalysts with improved thermal stability and reactivity for intermolecular alkyne hydroamination.

A series of 1,2,3-triazole-bound cationic Au(I) catalysts have been synthesized, and their structures have been characterized by X-ray crystallography. Variable-temperature NMR studies revealed dynamic triazole-Au cation coordination in solution. Reaction profiles clearly indicated that these new catalysts possess much better thermal stability than literature-reported Au catalysts, including IPrAu x NTf(2). By application of these catalysts, challenging intermolecular hydroaminations were achieved with less-reactive internal alkynes and unprotected aliphatic amines, giving excellent yields with low catalyst loading.

Highly efficient synthesis of vinyl substituted triazoles by Au(I) catalyzed alkyne activation.

Au(I) catalyzed 1,2,3-triazole addition to non-activated alkyne was reported. A large group of substituted NH-1,2,3-triazoles were suitable for this transformation along with both internal and terminal alkynes. The N-1 and N-2 vinyl substituted 1,2,3-triazoles were prepared in up to 98% yield with as low as 0.2% catalyst loading, thereby providing a new protocol for the synthesis of potentially biological-active vinyl-triazole building blocks.

One step cascade synthesis of 4,5-disubstituted-1,2,3-(NH)-triazoles.

A Lewis base-catalyzed three-component cascade reaction was developed for the synthesis of 4,5-disubstituted-1,2,3-(NH)-triazoles. More than 25 new (NH)-triazoles were prepared in good to excellent yields under mild conditions. The availability of the C-4 vinyl group allows easy conversion into other triazole derivatives.

Porokeratosis confined to the genital area: a report of three cases.

Genital involvement in porokeratosis (PK) is a rare occurrence even in disseminated forms. We encountered three patients who had porokeratosis affecting only the genital area. Two of them were male with involvement of the penis and scrotum and only the scrotum respectively. The lady with vulvar involvement is a hitherto unreported instance of porokeratosis confined to female genitalia. None of the cases were very easy to diagnose clinically but biopsies proved confirmatory. The male patients were advised light electrocautery under local anesthesia while the female patient underwent surgical excision. No malignant change has been reported in them till date.

Intermolecular cross-double-michael addition between nitro and carbonyl activated olefins as a new approach in C-C bond formation.

A novel intermolecular cross-double-Michael addition between nitro and carbonyl activated olefins has been developed through Lewis base catalysis. The reaction took place with a large group of beta-alkyl nitroalkenes and alpha,beta-unsaturated ketone/esters, producing an allylic nitro compound in good to excellent yields.

Mitsunobu coupling of nucleobases and alcohols: an efficient, practical synthesis for novel nonsugar carbon nucleosides.

A simple facile synthesis of substituted purine derivatives has been developed by using Mitsunobu conditions for an alcohol and a respective nucleobase. A wide range of alcohols produces good to excellent yield (>90%). The resulting purine analogues show good regioselectivity with N-9 substitution as the dominant products in most of the cases. Application of diastereospecific alcohols reveals a complete inversion of the carbon stereogenic center giving a single diastereomer. More than two dozen novel nucleobase derivatives have been prepared in high yield.